儿童及青少年心因性非癫痫性发作中的伦理困境
Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures.
作者信息
Cole Cristie M, Falcone Tatiana, Caplan Rochelle, Timmons-Mitchell Jane, Jares Kristine, Ford Paul J
机构信息
Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Neurological Institute, Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
出版信息
Epilepsy Behav. 2014 Aug;37:145-50. doi: 10.1016/j.yebeh.2014.06.019. Epub 2014 Jul 10.
To date, only a very narrow window of ethical dilemmas in psychogenic nonepileptic seizures (PNES) has been explored. Numerous distinct ethical dilemmas arise in diagnosing and treating pediatric and adolescent patients with PNESs. Important ethical values at stake include trust, transparency, confidentiality, professionalism, autonomy of all stakeholders, and justice. In order to further elucidate the ethical challenges in caring for this population, an ethical analysis of the special challenges faced in four specific domains is undertaken: (1) conducting and communicating a diagnosis of PNESs, (2) advising patients about full transparency and disclosure to community including patients' peers, (3) responding to requests to continue antiepileptic drugs, and (4) managing challenges arising from school policy and procedure. An analysis of these ethical issues is essential for the advancement of best care practices that promote the overall well-being of patients and their families.
迄今为止，仅对精神性非癫痫性发作（PNES）中非常狭窄范围内的伦理困境进行了探讨。在诊断和治疗患有PNES的儿科和青少年患者时会出现许多不同的伦理困境。所涉及的重要伦理价值包括信任、透明度、保密性、专业性、所有利益相关者的自主权以及公平性。为了进一步阐明照料这一人群时面临的伦理挑战，本文对四个特定领域所面临的特殊挑战进行伦理分析：（1）进行PNES的诊断并传达诊断结果，（2）建议患者向包括其同龄人在内的社区完全透明公开，（3）回应继续使用抗癫痫药物的请求，（4）应对学校政策和程序引发的挑战。对这些伦理问题进行分析对于推进促进患者及其家庭整体福祉的最佳护理实践至关重要。
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